Provider Demographics
NPI:1023044724
Name:ADVANCED DERMATOLOGY & SKIN SURGERY, PC
Entity Type:Organization
Organization Name:ADVANCED DERMATOLOGY & SKIN SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORDECHAI
Authorized Official - Middle Name:M
Authorized Official - Last Name:TARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-905-9200
Mailing Address - Street 1:886 RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5220
Mailing Address - Country:US
Mailing Address - Phone:732-905-9200
Mailing Address - Fax:
Practice Address - Street 1:886 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5220
Practice Address - Country:US
Practice Address - Phone:732-905-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07911600207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty